HEALTH CARE/Joan Retsinas

Immigrants Test Compassionate Conservatism

They make great campaign backdrops. Candidate X walks down a
street, buying water at the bodega, nibbling a roll from the Costa
Rican bakery, chatting with the Somalian worker. Candidate X bleats
on about the American dream, throwing in a quote from Emma
Lazarus.

They have invigorated our cities. In depressed inner city
neighborhoods, the small shops and restaurants have translated into
genuine economic renewal as vacant storefronts start sprouting "open"
signs.

They have enlivened our cuisine, introducing lemongrass, nasa
goreng and fajitas into our food-lexicon. In the deepest South and
the farthest West, fourth-generations Americans eat foods from places
they have never visited.

They take the jobs that those fourth-generation Americans don't
want &endash;- accepting minimum wage, or less, in under-the-table
transactions. They rarely demand Social Security or health insurance.
They work as maids, cooks, and gardeners. Candidate X probably
employs a few in his McMansion of a home.

Most of all, we laud their grit. Often with nothing but the
determination to work 18-hour days, whole families have wrested
enough from a small business to propel their children into the middle
class.

The "they" are the legal immigrants who have come here to start
afresh, testing Emma Lazarus's promise.

This year they are also testing our leaders' promise of
"compassionate conservatism." That was the campaign rhetoric that
promised to square the political circle: to cut government spending,
without hurting -&endash; indeed, while helping -- the people who
depended on that spending.

In 1996 immigrants fell outside the flimsy safety net of the
"welfare reform" legislation. That law barred states from using
federal money to pay for health insurance for immigrant women and
their children. Even though those women may be working beside
citizens, at the same jobs, and the same income, the federal rules
were explicit. States could not use their Medicaid dollars (or
Supplemental Children's Health Insurance money) to pay for health
insurance for these women until they had been in this country at
least 5 years. A legalistic loophole, moreover, made it difficult for
women to be eligible until they became citizens.

The consequence: lots of immigrant women and children have no
health insurance. As many as 30% of uninsured children live in
families of legal immigrants.

States can spend their own money to give health insurance to
immigrants. Most don't. California and Texas are two of the states
that do. Yet as states retrench on spending, that outlay becomes
harder.

This year Congress has a chance to stitch up that hole in welfare
reform's safety net. Tacked onto the Medicare Drug bill is a measure
(section 605) that would allow states to use their Medicaid and
Children's Health Insurance Programs to give health insurance to
immigrant women and children. The section would not force states to
add these clients to their insurance rolls, but the fact that states
could use federal dollars toward this insurance suggests that most
would. The measure has also been introduced independently: the
Immigrant Children's Health Improvement Act. The Congressional Budget
Office estimates that this measure would help 155,055 children and
60,000 pregnant women.

Rationally, this measure should pass. Its supporters include the
American Medical Association, the American Academy of Pediatrics, the
National Governors Association, the National Council of La Raza, and
the Children's Defense Fund. Yet 33 Senators voted to strip section
605 from the Medicare drug bill. (Fortunately, 65 voted to keep it
in).

Today's leaders bleat on about "fiscal austerity"and "tightening
our collective belt." Except for a few iconoclasts, politicians sing
the virtues of conservatism. We should remind them that they promised
to couple "compassion" with the conservatism.

Joan Retsinas is a sociologist who writes about health care in
Providence, R.I.